| Outcome Correlation of Smear-positivity for Acid-fast Bacilli on the Fifth Month of Treatment in Non-Multidrug Resistant Tuberculosis. | |
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MedLine Citation:
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PMID: 23288018 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT BACKGROUND: Sputum samples from patients with non-multidrug-resistant (non-MDR) pulmonary tuberculosis (TB) may remain smear-positive for acid-fast bacilli (AFB) on the 5th month of anti-TB treatment. However, its significance remains unknown. METHODS: From January 2004 to April 2009, there were 5403 patients with culture-confirmed pulmonary TB from in four hospitals in Taiwan. Among them, 116 (2.2%) non-MDR-TB patients whose sputum samples were smear-positive by concentration smear method on the 5th month of treatment were evaluated. RESULTS: Sputum culture yielded Mycobacterium tuberculosis in 10 patients (8.6%, MTB group), non-tuberculous mycobacteria in 23 (19.8%, NTM group), and no-growth in the remaining 83 (71.6%, no-growth group). The relapse rate (22%) was higher in the MTB group (p=0.01). Four predictors, smear grading ≥3+ on the 5th month ["S"] (OR:10.73, 2.67-43.17), no sputum culture conversion on the 2nd month ["C"] (OR:7.16, 1.45-35.44), lack of Directly Observed Therapy ["O"] (OR:6.40, 1.54-26.56), and no radiographic improvement on the 5th month ["R"] (OR:4.18, 1.02-17.10), were associated with viable M. tuberculosis (MTB group). An integrated "SCOR" index of 1 point for each positive factor had the best discriminatory power for predicting culture results on the 5th month. If the "SCOR" index was 0, all smear-positive sputum was culture-negative for M. tuberculosis. CONCLUSIONS: Positive sputum smears by a concentrated smear method on the 5th month of treatment in non-MDR TB patients, especially those with a low "SCOR" index, may be due to non-viable bacilli and NTM. Careful review of the quality of patient supervision, bacteriologic data, and chest radiography is crucial. |
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Authors:
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Jung-Yien Chien; Yi-Ting Chen; Chin-Chung Shu; Jen-Jyh Lee; Jann-Yuan Wang; Chong-Jen Yu; Pan-Chyr Yang |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-1-3 |
Journal Detail:
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Title: Chest Volume: - ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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